Efficacy of Combined Thrombomodulin and Antithrombin in Anticoagulant Therapy for Acute Cholangitis-induced Disseminated Intravascular Coagulation

Nozomi Morita; Kazunari Nakahara; Ryo Morita; Keigo Suetani; Yosuke Michikawa; Junya Sato; Kensuke Tsuji; Hiroki Ikeda; Kotaro Matsunaga; Tsunamasa Watanabe; Nobuyuki Matsumoto; Chiaki Okuse; Michihiro Suzuki; Fumio Itoh

doi:10.2169/internalmedicine.1923-18

ORIGINAL ARTICLES

Efficacy of Combined Thrombomodulin and Antithrombin in Anticoagulant Therapy for Acute Cholangitis-induced Disseminated Intravascular Coagulation

Nozomi Morita, Kazunari Nakahara, Ryo Morita, Keigo Suetani, Yosuke Michikawa, Junya Sato, Kensuke Tsuji, Hiroki Ikeda, Kotaro Matsunaga, Tsunamasa Watanabe, Nobuyuki Matsumoto, Chiaki Okuse, Michihiro Suzuki, Fumio Itoh

Author information

Nozomi Morita
Department of Gastroenterology and Hepatology, Kawasaki Municipal Tama Hospital, Japan
Kazunari Nakahara
Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Japan
Ryo Morita
Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Japan
Keigo Suetani
Department of Gastroenterology and Hepatology, Kawasaki Municipal Tama Hospital, Japan
Yosuke Michikawa
Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Japan
Junya Sato
Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Japan
Kensuke Tsuji
Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Japan
Hiroki Ikeda
Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Japan
Kotaro Matsunaga
Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Japan
Tsunamasa Watanabe
Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Japan
Nobuyuki Matsumoto
Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Japan
Chiaki Okuse
Department of Gastroenterology and Hepatology, Kawasaki Municipal Tama Hospital, Japan
Michihiro Suzuki
Department of Gastroenterology and Hepatology, Kawasaki Municipal Tama Hospital, Japan
Fumio Itoh
Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Japan

Keywords: disseminated intravascular coagulation, acute cholangitis, thrombomodulin, antithrombin, biliary drainage

JOURNAL OPEN ACCESS

2019 Volume 58 Issue 7 Pages 907-914

DOI https://doi.org/10.2169/internalmedicine.1923-18

Browse “Advance online publication” version

Details

Abstract

Objective The efficacy and safety of concomitant use of antithrombin (AT) with recombinant human soluble thrombomodulin (rTM) for acute cholangitis-induced disseminated intravascular coagulation (AC-induced DIC) remains unclear. This study was conducted to investigate the efficacy of AT combined with rTM as anticoagulant therapy for AC-induced DIC.

Methods One hundred patients with AC-induced DIC received anticoagulant therapy using rTM from April 2010 to December 2017. Of the 83 patients treated with rTM immediately after the diagnosis of DIC, excluding those who had not undergone biliary drainage or who had malignancies or a serum AT III level >70%, 56 patients were studied. Outcomes and adverse events (AEs) were retrospectively compared between the 16 patients treated with rTM alone (rTM group) and the 40 patients treated with rTM and AT (rTM+AT group).

Results Patients' background characteristics did not differ markedly, except for a significantly higher serum D-dimer level in the rTM group than in the rTM+AT group (p=0.038). The DIC resolution rates on day 9 were 100% and 95.1% in the rTM and rTM+AT groups, respectively (p=0.909). The mean DIC scores were significantly lower in the rTM group than in the rTM+AT group on days 3 (p=0.012), 5 (p<0.001), 7 (p=0.033), and 9 (p=0.007). The incidence of AEs was 6.3% and 10.0% (p=0.941), and the in-hospital mortality rates was 0% and 5.0% (p=0.909) in the rTM and rTM+AT groups, respectively.

Conclusion The concomitant use of AT with anticoagulant therapy using rTM for AC-induced DIC may not help improve the treatment outcome.

Corresponding author

Register with J-STAGE for free!